Partnership With Department of Children and Families Yields Education, Awareness and Medical Guidelines

HARTFORD -- Department of Children and Families (DCF) Commissioner Joette Katz thanked the medical community for its work to improve the recognition and reporting of child abuse when a child presents in a medical setting with a traumatic injury.

At a press conference today at Hartford Hospital, together with Dr. Lenworth Jacobs, director of the hospital's Emergency Medical Services trauma unit and chairman of the Connecticut Committee on Trauma, Commissioner Katz said activities to educate, raise awareness and provide support to medical personnel will result in a better system for protecting children.

"Keeping children safe is a team activity," Commissioner Katz said. "Parents have primary responsibility. But if they cannot keep their children safe, then the larger community has to come together to protect children.

"This partnership between the DCF and the medical community is a prime example of working together in the common interest of keeping children safe," the Commissioner added.

Commissioner Katz said educating and raising awareness among medical professionals stands at the center of the effort. She applauded Dr. Jacobs and the trauma committee as well as the pediatric child abuse subcommittee that developed and unanimously approved guidelines to improve child abuse recognition. The commissioner noted the two guidelines pertaining to children under the age of six -- that available medical records are evaluated and that disrobing the child and placing him/her in a hospital gown enables a thorough physical examination -- reflect the fact that very young children are the most at risk. Because many children under six do not attend school, community providers have less opportunity to detect signs of child abuse.

Commissioner Katz said efforts are underway to expand existing education for medical providers. The pediatric centers at Yale-NewHavenHospital and at Connecticut Children's MedicalCenter both have child abuse experts who educate and consult with hospitals and medical professionals on the detection and reporting of child abuse. Both pediatric centers are continuing this work and also have joined a multi-disciplinary workgroup that consists of advocates, nurses, physicians, and DCF staff to enhance ongoing education and awareness efforts. The committee has begun to identify tools and opportunities to expand medical, community, and school-based provider education of child abuse recognition.

"The medical community has already demonstrated its commitment to protect children through identifying best practices and educating its members on the best way to find red flags and recognize abuse," Commissioner Katz said. "Now we are ready to stand together to continue improvements to how we respond to potential child victims."

Despite these efforts, Commissioner Katz said there is no magic that will make the problem of identifying abuse go away.

"Detecting child abuse is not an easy or simple task," she said. "We know that not every child injury -- or even death -- can be averted. But by detecting abuse as soon as possible after it starts, we are intervening early and possibly preventing something much worse in the future."

Dr. Andrea Asnes, assistant professor of pediatrics at the Yale School of Medicine and a child abuse expert at the Yale-New Haven Hospital who regularly educates and consults with medical providers on issues surrounding child abuse, said the guidelines will be a support to medical providers.

"Increasing the use of medical records to flag past injuries and reports to DCF will be a valuable tool in enhancing frontline providers’ recognition of child physical abuse,” Dr. Asnes said. "When signs of possible abuse are identified, thorough workup, including disrobing and full examination of children, will be a valuable tool in enhancing the detection of child physical abuse."

Dr. Asnes said education is essential, as is the ability to consult with experts.

"Child physical abuse often presents with subtle and superficial injuries that require an appropriate threshold of concern in order to be detected and adequately evaluated," Dr. Asnes said. "Frontline providers need and deserve high quality and continuous education about how to recognize subtle signs of child physical abuse. Frontline providers need and deserve high quality and continuous support with managing suspected child abuse. Real time availability of consultant providers with expertise in the recognition of and appropriate workup of injuries suspicious for child abuse will be an important component of such support."

Jennifer Jackson, President and CEO of the Connecticut Hospital Association, said the hospitals are eager to play their part of a larger response to child safety.

“Connecticut hospitals, their emergency departments, the Department of Children and Families, and the Department of Public Health have a shared goal of protecting our children through detecting and reporting child abuse,” said Ms. Jackson. “We appreciate this opportunity to work together to help healthcare providers ensure the safety of children, and we look forward to continuing our collaboration on this important issue.”

Commissioner Katz said taking a multi-disciplinary approach to detecting and preventing child abuse is the most effective way to protect children.

"A total effort involves home, school and community in an encompassing and broad way," she said. "Different areas of expertise and experience need to be brought together so that we can be as effective as possible."

Commissioner Katz said a number of other activities are underway to raise awareness and recognition involving a broad array of professional disciplines, including:

Consultation by the pediatric centers at Yale and CCMC with the DCF Careline to improve the manner in which the department gathers and assesses information from mandated reporters;

Training for mandated reporters -- including school personnel -- that occurs at the DCFAcademy and also online through web-based videos developed by the Academy;

Ongoing teleconference trainings with the Connecticut Chapter of the AmericanAcademy of Pediatrics; and

Work by Multi-Disciplinary Teams around Connecticut to bring medical, clinical, and legal professional expertise together to raise awareness and increase the effectiveness of community responses to abused children.